Percutaneous Transforaminal Endoscopic Discectomy for Adjacent Segment Disease After Lumbar Fusion in Elderly Patients Over 65 Years Old.

Abstract

To evaluate short-term efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) in treatment of symptomatic adjacent segment disease (ASD) after lumbar fusion in elderly patients >65 years old. Patients >65 years old who underwent PTED for ASD after lumbar fusion between January 2013 and September 2016 were retrospectively evaluated. Demographics and perioperative clinical data were collected from medical records. MacNab classification, visual analog scale, Oswestry Disability Index, and Japanese Orthopaedic Association scores as well as 36-Item Short-Form Health Survey were used to assess the efficacy of PTED. We evaluated 25 consecutive patients >65 years old with ASD (11 men, 14 women; mean age 74.65 ± 9.61 years). Mean follow-up time was 37.14 ± 11.60 months. Of patients, 84.0% (21/25) had excellent or good clinical outcomes, 12.0% (3/25) had fair outcomes, and 4.0% (1/25) had poor outcomes. Complications included 1 dural laceration, 1 postoperative dysesthesia, and 1 recurrence. For patient-reported outcomes, significant improvements were observed postoperatively compared with preoperatively in visual analog scale (P < 0.05), Oswestry Disability Index (P < 0.05), Japanese Orthopaedic Association (P < 0.05), and 36-Item Short-Form Health Survey (P < 0.05). PTED demonstrated satisfactory short-term efficacy and safety in management of ASD after lumbar fusion in patients >65 years old. PTED may be an alternative choice for elderly patients with ASD after lumbar fusion.